Impact of sarcopenia on mortality in patients undergoing liver retransplantation

• 作者: Amaninder Dhaliwal Diana Larson Fedja A Rochling Harlan Sayles Lyudmila M Muinov Marco A Olivera Molly Hiat Timothy M McCashland Tomoki Sempokuya William L Harrison
• 来源期刊: 世界肝病学杂志:英文版(电子版)
• 学科: 医学
• 关键词: SARCOPENIA Liver transplantation MORTALITY Re-transplantation Psoas muscle index
• 年，卷（期）: 2020,（10）
• 页码范围: 807-815
• 页数: 9页
• 分类号: R73

摘要

BACKGROUND Sarcopenia,which is a loss of skeletal muscle mass,has been reported to increase post-transplant mortality and morbidity in patients undergoing the first liver transplant.Cross-sectional imaging modalities typically determine sarcopenia in patients with cirrhosis by measuring core abdominal musculatures.However,there is limited evidence for sarcopenia related outcomes in patients undergoing liver re-transplantation(re-OLT).AIM To evaluate the risk of mortality in patients with pre-existing sarcopenia following liver re-OLT.METHODS This is a retrospective study of all adult patients who had undergone a liver re-OLT at the University of Nebraska Medical Center from January 1,2007 to January 1,2017.We divided patients into sarcopenia and no sarcopenia groups.“TeraRecon AquariusNet 4.4.12.194”software was used to evaluate computed tomography or magnetic resonance imaging of the patients done within one year prior to their re-OLT,to calculate the Psoas muscle area at L3-L4 intervertebral disc.We defined cutoffs for sarcopenia as<1561 mm2 for males and<1464 mm2 for females.The primary outcome was to compare 90 d,one,and 5-year survival rates.We also compared complications after re-OLT,length of stay,and readmission within 30 d.Survival analysis was performed with Kaplan-Meier survival analysis.Continuous variables were evaluated with Wilcoxon rank-sum tests.Categorical variables were evaluated with Fisher’s exact tests.RESULTS Fifty-seven patients were included,32 males:25 females,median age 50 years.Two patients were excluded due to incomplete information.Overall,47%(26)of patients who underwent re-OLT had sarcopenia.Females were found to have significantly more sarcopenia than males(73%vs 17%,P<0.001).Median model for end stage liver disease at re-OLT was 28 in both sarcopenia and no sarcopenia groups.Patients in the no sarcopenia group had a trend of longer median time between the first and second transplant(36.5 mo vs 16.7 mo).Biological markers,outcome parameters,and survival at 90 d,1 and 5 years